4.2.3 Hirsutism

Grading & Level of Importance: B


W. Burgdorf, Munich; S. Chee, A. Salam, J. McGrath, London;
Revised by J. White, V. del Marmol, Brussels




Hirsutes, excessive hair, endocrine hypertrichosis.


Excessive terminal hair in a male pattern in a woman.

Aetiology & Pathogenesis

Around 5-10% of women may show signs of hirsutism.
There are many different causes.

Endocrine hirsutism: polycystic ovary syndrome; androgen-producing ovarian tumours; congenital adrenal hyperplasia (adrenogenital syndrome); acanthosis nigricans in insulin resistance, adrenal tumours; ACTH-cell hyperplasia; pituitary adenomas (Cushing’s disease); hyperprolactinemia; acromegaly.

Other causes: postmenopausal hirsutism; idiopathic hirsutism; ethnic; medication-induced hirsutism (e.g. anabolic steroids), paraneoplastic.

Signs & Symptoms

Growth of terminal and vellus hairs in woman on upper lip, chin, temples, between breasts, around nipples, on shoulders, linea alba and interior aspects of thighs. Can vary from discrete excess hairs to obvious male pattern with involvement of different locations that are highly variable.


Upper lip, chin, temples, breast, abdomen, pubic area, arms, legs, back, buttocks.


Modified Ferriman-Gallwey system with 19 locations, min 0 to 36 max points. A score of more than 8 indicates androgen excess hirsutism.

Laboratory & other workups

Hormone status (FSH/LH ratio, DHEAS, free testosterone, SHBG,17-hydroxyprogesterone, prolactin), transvaginal ultrasound evaluation of ovaries.


Usually not required.


Persistent, if an underlying cause cannot be found or treated adequately.


Psychosocial problems, tendency towards folliculitis after shaving, diabetes and cancer in polycystic ovarian syndrome.


Typical hair pattern, endocrine screening with more detailed evaluation if hyperandrogenism is present.

Differential diagnosis

Ethnic variability. Hypertrichosis. Virilisation. Genetic syndromes causing hypertrichosis (consider especially in children).

Prevention & Therapy

Treat causes of hyperandrogenism.

Mechanical removal of hairs includes shaving, waxing, epilation, electroepilation, laser or light-assisted hair removal. Chemical agents to slow/stop hair growth (e.g. eflornithine). Consider spironolactone, finasteride, cyproterone or oral contraceptives.


Psychosocial support.

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